Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 111

International Journal of Drug Research and

Technology

Available online at http://www.ijdrt.com

Research Article

STUDY OF ANTIHYPERTENSIVE DRUG UTILIZATION PATTERN

IN CHRONIC KIDNEY DISEASE PATIENTS

Amish Uprety*

Nargund College of pharmacy Bangalore, Karnataka, India.

ABSTRACT

Introduction: Hypertension is a chronic illness associated with high morbidity & mortality,

with a rising number of patients with hypertension and chronic kidney disease, achieving

blood pressure of less than 140/90 mm of Hg is challenging. Hence, there is a need for

appropriate, safe, effective and economical study to find out the patterns of drug therapy.

Objectives: To evaluate utilization patterns of antihypertensive agents in chronic kidney

disease patients.

Methodology: A prospective observational study was conducted for a period of 6 months in

Jayanagar General Hospital, Bengaluru. We included 70 hypertensive CKD patients. Detailed

patient information data were noted, and data entered in a preformed proforma in Microsoft

Excel sheet for compilation and subjected to statistical analysis.

Results: Total 70 case records of patients having chronic kidney disease were analysed.

Mean age was 52.08 ± 15.14. CKD was more prevalent in males 38 (54.2%) and 32 (46.8%)

females with male to female ratio of 2.3:2. Most of the patients (52.80%) belonged tote age

group of 41-60 years. Among the anti-hypertensive agents, most frequently used was calcium

channel blockers (91.4%), followed by diuretics (54.2%), Beta blockers (31.4%), alpha

blockers, ACE inhibitors and ARB.

Conclusion: Dual and triple therapy were prescribed which was according to ESH

guidelines. This study highlights some therapeutic rationality in this health centre. However,

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 112

targeted education of the prescription-givers and dissemination of treatment guideline could

facilitate rational use of drugs and adherence to treatment guidelines.

Keywords: Hypertension; Chronic kidney disease; Drug utilization; ESH Guidelines;

Treatment.

INTRODUCTION

According to WHO, Hypertension is defined as a systolic blood pressure (SBP) of 140

mmHg or more, or a diastolic blood pressure (DBP) of 90 mmHg or more. Hypertension is a

common disease that is simply defined as persistently elevated arterial blood pressure (BP).

Although elevated BP was perceived to be “essential” for adequate perfusion of essential

organs during the early and middle 1900s, it is now identified as one of the most significant

risk factors for cardiovascular (CV) disease. Increasing awareness and diagnosis of

hypertension, and improving control of BP with appropriate treatment, are considered critical

public health initiatives to reduce CV morbidity and mortality. Hypertension is an important

public health challenge in both economically developing and developed countries. In India,

cardiovascular diseases (CVDs) are estimated to be responsible for 1.5 million deaths

annually. Hypertension is a major risk factor for CVDs, including stroke and myocardial

infarction, and its burden is increasing disproportionately in developing countries as they

undergo demographic transition.

Complications of Hypertension

Stroke

Cerebral/brainstem infarction

Cerebral haemorrhage

Lacunar syndromes

Multi-infarct disease

Hypertensive encephalopathy/ malignant hypertension

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 113

Dissecting aortic aneurysm

Hypertensive nephron-sclerosis

Peripheral vascular disease (Walker R et al., 2012)

Globally CKD is a major threat because of an increasing incidence, long term hospital stay,

high cost of treatment and poor outcome associated with various complications and co-

morbidities. CKD is an array of heterogeneous disorders affecting renal architecture and

function as well. The Kidney Disease Outcomes Quality Initiative (KDOQI) of the National

Kidney Foundation defines CKD as kidney damage and/or a decreased glomerular filtration

rate of less than 60 mL/min/1.73 m2

for three months or more. Hypertension (HTN) has been

reported in most of patients with CKD (Stages III-V). (Kearney PM et al., 2004)

In India, the incidence of CKD is rising, and as per estimates from 006, the age-adjusted

incidence rate of end-stage renal disease (ESRD) is 229 per million populations. Further, the

number of new patients entering renal replacement programs annually is >100,000. The

rising incidence of CKD in India is likely to burden healthcare and the economy in the future

(Walker R et al., 2012).

Study Criteria

Inclusion Criteria:

Patients treated for hypertension and chronic kidney disease with or without other co

morbid conditions like Diabetes mellitus, and other associated cardiovascular

diseases.

Exclusion Criteria:

Pregnant and lactating patients.

Age below 18 and above 90 years.

Terminally ill patients co-infected with HIV or Hepatitis or with any infective

conditions or with any autoimmune diseases or continuing medications for the same.

Patients with renal transplant.

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 114

MATERIAL AND METHODS

A descriptive, prospective and hospital-based study was conducted in Jayanagar General

Hospital, Bangalore over a period of 6 months, after obtaining the clearance and approval

from the Institutional Ethics Committee, 70 in-patients were included in the study. The

patients were diagnosed of having Chronic Kidney Disease by the consultant Nephrologist

according to KDOQI guidelines.

Statistical analysis

Descriptive statistics is done by measuring different proportions. statistical measurement was

done in SPSS trial version 24.0. Graphical representation was done in using Microsoft Excel.

RESULTS

Gender wise distribution

During the study period, a total of 70 hypertensive patients were included. Out of 70 patients,

38 (54.2%) were male and 32 (45.8%) were females (Table 1 and Figure 1).

Table 1: Gender wise distribution of patients

S. No Gender Numbers Percentage (%)

1 Male 38 54.2

2 Female 32 45.8

Figure 1: Gender wise distribution of patients.

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 115

Age wise distribution

Out of 50 patients, 37 (52.8%) belonged to age group of 41-60 years, followed by 17 (24.2%)

belonged to 61-80 years and 12 (17.1%) belonged to 21-40 years. Mean age in study subject

was 52.08 ± 15.14 years (Table 2).

Table 2: Age wise distribution of hypertension

S. No Age group Total No Males Females Total percentage (%)

1 18-20 2 1 1 2.8

2 21-40 12 6 6 17.1

3 41-60 37 23 14 52.8

4 61-80 17 7 10 24.2

5 >80 2 1 1 2.8

Distribution of patients based on social habits

Out of 70 patients, we found that 13 (18.5%) patients were smokers alone in which 8 (61.5%)

were males and 5 (38.4%) were females and 14 (20%) patients were alcoholic in which 8

(57.1%) were males and 6 (42.8%) were in females. Patients having habit of both alcoholic

and smoking were found to be 23 (32.8%) in which 19 (82.6%) were males and 4 917.3%)

were females. 20 patients have not had any habits mentioned (Table 3).

Table 3: Social habits of the patients

S. No. Social Habits Total Male Female

1 Smokers 13 8 5

2 Alcoholics 14 8 6

3 Both 23 19 4

4 None 20 3 17

Comorbid conditions

Majority of the patients were suffering from concurrent diabetes mellitus (50%). Other

commonly associated conditions were Anaemia (15.7%), Cardiovascular Disease (0.42%),

Urinary Tract Infection (0.57%), Chronic Liver Disease (0.14%), Pulmonary Tuberculosis

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 116

(0.14%), Hypothyroidism (0.28%), Retinopathy (0.14%) and Seizures (0.14%) (Table 4 and

Figure 2).

Table 4: Co-morbid conditions.

S. No Co-morbid conditions Total Male Female

1 Diabetes Mellitus 35 16 19

2 Anemia 11 6 5

3 Cardiovascular Disease 3 1 2

4 Urinary Tract Infection 3 1 2

5 Chronic Liver Disease 1 1 0

6 Pulmonary Tuberculosis 1 1 0

7 Hypothyroidism 2 0 2

8 Retinopathy 1 1 0

9 Seizures 1 1 0

Figure 2: Co-morbid conditions.

Antihypertensive drugs use pattern

In our study, out of 70 patients we concluded that 39 patients had received two anti-

hypertensive drugs (55.7%), followed by both one and three anti-hypertensive drugs (25.7%)

and four antihypertensive drugs. Among the antihypertensive drugs, amlodipine (CCB) was

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 117

the most commonly prescribed drug (80%) followed by furosemide (loop diuretic) (48.5%),

metoprolol (beta blocker) (31.4%), cilnidipine (CCB) (11.4%), torsemide (diuretic) (5.7%)

telmisrtan (ARB) (5.7%), losartan (ARB) (2.85%), prazosin (alpha blocker) (10%), clonidine

(centrally acting alpha-agonist) (10%), metoprolol (beta blocker) (4%) and enalapril (ACEI)

(1.42%), chlorothalidone (thiazide diuretic) (1.42%),captopril (ACEI) (1.42%) (Table 5 and

Figure 3).

Table 5: Number of prescriptions with anti-hypertensive drugs.

S. No Anti-Hypertensive Drugs either given alone or in

Combinations

Percentage of

Prescriptions

1 Patients treated with Calcium channel blocking agents 91.4

2 Patients treated with Beta - Adreno receptor Blocking agents 31.4

3 Patients treated with Diuretics 54.2

4 Patients treated with ACE inhibitors 2.85

5 Patients treated with Alpha – adreno receptor Blocking agents 10

6 Patients treated with Angiotensin Receptor Antagonist 8.5

7 Patients treated with Centrally acting anti-hypertensive agent

(Clonidine) 10

Figure 3: Anti-hypertensive agents use pattern.

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 118

Combination therapy (Table 6)

Table 6: Number of combination therapy.

Therapy No. of Prescription Percentage (%)

Mono therapy 18 25.7

Dual Therapy 29 41.4

Triple Therapy 18 25.7

Combination of four 5 7.14

Percentage adherence to ESH 2018 GUIDILINES: HT+CKD

Out of 70 patients 47 were prescribed in accordance to the ESH guidelines European society

of hypertension. Percentage adherence to ESH guideline in relation to treatment of

hypertensive patients with compelling indication (s) was found to be 67.1% (Table 7).

Table 7: Percentage adherence to European society of hypertension.

Variables No. of prescriptions Percentage (%)

Adherence 47 67.1

Nonadherence 23 32.9

Categorization of hypertensive patients based on blood pressure reading

In our study that included 70 hypertensive CKD patients, 5 were having severe hypertension

requiring intensive anti-hypertensive therapy with more than one antihypertensive agent, 13

were having moderate hypertension requiring pharmacological intervention and remaining 32

were in controlled blood pressure. The categorization is done based on ESH Guidelines 2018

(Table 8 and Figure 4).

Table 8: Categorization of hypertensive patients based on blood pressure reading.

S. No. Blood Pressure Reading No. of Patients

1 Hypertension (Grade 1) 16

2 Hypertension (Grade 2) 7

3 Hypertension (Grade 3) 13

4 Hypertension (Normal) 13

5 Hypertension (High Normal) 21

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 119

Figure 4: Categorization of hypertensive patients based on blood pressure reading (ESH

Guidelines 2018).

Categorization chronic kidney disease patients according to eGFR with MDRD Method

Out of the 70 patients, 42 patients were in stage 5 (60%) among them 26 (61.9%) were male

and 16 (38.09%) were female. 13 were in stage 4 (18.5%) among them 6 (46.1%) were male

and 7 (53.85) were female. 13 patients were in stage 3 (18.5%) among that 4 (30.7%) were

male and 9 (69.2%) were male. 1 patient in stage 1 and 1 patient in stage 2 which of them

were male (Table 9 and Figure 5).

Table 9: Categorization chronic kidney disease patients according to eGFR with MDRD

method.

S. No. Stages Total patients Male Female

1 Stage 1 1 1 0

2 Stage 2 1 1 0

3 Stage 3 13 4 9

4 Stage 4 13 6 7

5 Stage 5 42 26 16

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 120

Figure 5: Categorization chronic kidney disease patients according to eGFR with MDRD

method.

DISCUSSION

Drug utilization study is described as “The marketing, distribution, prescription and

utilization of drugs in the society, with special attention to the resulting medical, social and

economic consequences” and has the main objective of facilitating the rational use of drugs

which is very important in decision making for healthcare set ups. A prescription survey is

one of the most effective methods to evaluate the prescribing attitude of doctors. It is also

important to consider the guidelines of international regulatory associations on the

management of hypertension that will improve prescribing practice of the physicians and

ultimately, the clinical standards. This practice will eventually, help to promote rational use

of drugs (Abhisek PA et al., 2017).

The study on antihypertensive drug utilization pattern in presence of chronic kidney disease

included 70 patients. According to gender wise distribution it was found that males were

slightly more predisposed to the HTN with CKD than females. A similar study concluded

that male population was (58.4%) slightly at the higher end for the condition than the

females, which was like our study (Sarafidis PA et al., 2012; Verberne WR et al., 2019).

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 121

Another study in Odisha reveals the mean age of the hypertensive CKD patients was 49.26

±11.46 years somewhat close to our study results that is 52.08 ± 15.14 years (Abhisek PA et

al., 2017).

In our prescription-based survey, the prominent findings were, out of 70 prescriptions, most

of the subjects were of the age group between 41-60 years of age. Two patients were found

between 18-20 and two above 80 years of age, this distribution shows that the age group of

41-60 were more prone to have CKD along with hypertension. According to a study

conducted in Cuttack, majority of the patients were in the age group of 41-60 years compared

to other age groups reflecting the similar pattern with our study years (Abhisek PA et al.,

2017).

In our survey, combination therapy was most widely prescribed regimen by the physicians.

Earlier studies have revealed that an ideal combination must have antihypertensive drugs

possessing complementary modes of action that provide a synergistic effect with minimal

adverse effects. Most hypertensive diabetic patients with normal renal function require a

combination of two to three antihypertensive agents to lower blood pressure to <130/80

mmHg; patients with concomitant chronic kidney disease may require three or more agents.

Combination therapy is required for optimal blood pressure control and prevention of

cardiovascular, renal and neurological complications.

Out of 70 patients, we found that 13 (18.5%) patients were smokers alone in which 8 (61.5%)

were males and 5 (38.4%) were females and 14 (20%) patients were alcoholic in which 8

(57.1%) were males and 6 (42.8%) were in females. Patients having habit of both alcoholic

and smoking were found to be 23 (32.8%) in which 19 (82.6%) were males and 4917.3%)

were females. 20 patients have not had any habits mentioned.

In this survey, most commonly prescribed monotherapy was calcium channel blocker (80%)

in our study corroborate with the study (Bailie GR et al., 2005). In our study the second most

used mono therapy was by loop diuretics (48.5%) however in another study, the most

prescribed drug class was ACE inhibitors /ARB which is not similar with our results. In

elderly patients, the preferred antihypertensive by the physicians were calcium channel

blockers (Magvanjav O et al., 2019).

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 122

Our study elicited that most of the patient who were hospitalized were in Stage V (60%)

followed by stage 4 (18%) and stage 3 (18%).

Co-morbidities associated with hypertension and CKD were seen in all 52 patients, Diabetes

mellitus in 67.3%, anaemia in 21% and other conditions included urinary tract infection and

those related to CVS. Most of the studies have shown diabetes mellitus as the favourite co-

morbidity in the similar patients.

These findings indicate that medication use was consistent with the international

recommendations from JNC 8 and European Society of Hypertension among hypertensive

CKD patients (James PA et al., 2014).

CONCLUSION

Amlodipine and furosemide were the most frequently prescribed antihypertensive drugs.

Prescription of antihypertensive drugs for some patients with compelling indications

(specifically CKD), were very much congruent with ESH guideline. This study highlights

some therapeutic rationality in this health centre. However, targeted education of the

prescription-givers and dissemination of treatment guideline could facilitate more rational use

of drugs and better therapeutic outcomes.

Control of hypertension and maintenance of ideal blood pressure is the root point that would

benefit the CKD patients most maintaining their renal health and related complications.

Pharmacists must become more vigilant about current guidelines for the treatment as well as

the ADR detection of some antihypertensive which can impact renal functions on patients

with concomitant hypertension and Chronic Kidney Disease.

Strategies such as patient education and medication assessment can help to optimize care for

these patients and slow the progression to chronic kidney disease. Many patients with CKD

and hypertension are still out of reach of specialized care. Specific risk factors determined

may aid in identifying patients at high-risk for inadequate treatment. Patient and education

provider, public health approaches, and health system changes are needed to address these

issues. As the population grows older renal function also tend to decrease proportionally,

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 123

hence kidney injuries becomes more prominent at the same time condition as hypertension

tend to double the risk factor for such age group.

LIMITATIONS

In spite of several limitations like inadequate sample size, study duration, point prevalence

nature of the collected data and being unicentric, this study provided a profile of drug

utilisation pattern in hypertensive CKD patients compared by class and also individualistic

comparison of drugs in the same class. This study will serve as a basis for future comparison.

Certain areas like potential drug-drug interaction, AEs and adherence are needed to be

explored further.

Fair portion of the drugs were prescribed from the prescribers and all the available

medication in hospital were written in generic name. So, it is the need of the hour to avail all

the required medication in the institution to prescribe rationally. Continuous prescription

audit from the clinical pharmacists in government sector will improve the utilization pattern

and therapeutic outcomes in economically challenged hypertensive CKD patients.

REFERENCES

1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, Floyd J, Fornage

M, Gillespie C, Isasi CR, Jiménez MC (2017) “Heart disease and stroke statistics-

2017 update: A report from the American Heart Association.” Circ 135: e146-603.

2. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM (2008)

“Pharmacotherapy: A pathophysiologic approach” 7th edn, New York, USA.

McGraw Hill Medical 139-151.

3. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J (2004) “Worldwide

prevalence of hypertension: a systematic review.” J Hypertens 22: 11-19.

4. Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P,

Mills A, Musgrove P (2006) “Disease control priorities in developing countries.”

World Bank p: 645-662.

5. Walker R, Whittlesea C (2012) “Clinical pharmacy and therapeutics.” 5th

Ed.

Edinburg: Churchill Livingstone. Elsevier p 295-311.

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 124

6. Solanki KC, Mistry RA, Singh AP, Jadav SP, Patel NM, Trivedi HR (2013) “Drug

utilization study of anti-hypertensive drugs and their adverse effects in patients of a

tertiary care hospital.” J Clin Exp Res 1: 58-67.

7. Lenfant C, Chobanian AV, Jones DW, Roccella EJ (2003) “Seventh report of the

Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of

High Blood Pressure (JNC 7) resetting the hypertension sails.” Circ 107: 2993-2994.

8. Ravera M, Re M, Deferrari L, Vettoretti S, Deferrari G (2006) “Importance of blood

pressure control in chronic kidney disease.” J Am Soc Nephrol 17: S98-103.

9. Morgado E, Neves PL (2012) “Hypertension and chronic kidney disease: cause and

consequence–therapeutic considerations. In Antihypertensive drugs” IntechOpen p:

45-66.

10. Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S (2003) “Blood pressure

predicts risk of developing end-stage renal disease in men and women.” Hypertens

41: 1341-1345.

11. Verberne WR, Das-Gupta Z, Allegretti AS, Bart HA, Van Biesen W, García-García

G, Gibbons E, Parra E, Hemmelder MH, Jager KJ and Ketteler M (2019)

“Development of an International Standard Set of Value-Based Outcome Measures

for Patients With Chronic Kidney Disease: A Report of the International Consortium

for Health Outcomes Measurement (ICHOM) CKD Working Group.” Am J Kidney

Dis 73: 372-384.

12. Abhisek PA, Panda R, Samal R, Mohapapatra N, Mohanty S (2017) “Drug utilisation

pattern and adverse events in patients with chronic kidney disease undergoing

maintenance haemodialysis at a Tertiary Care Hospital of Odisha.” J Clin Diagn Res

11: 11-16.

13. Abraham G, Arun K, Gopalakrishnan N, Renuka S, Pahari DK, Deshpande P, Isaacs

R, Chafekar DS, Kher V, Almeida AF, Sakhuja V (2017) “Management of

hypertension in chronic kidney disease: Consensus statement by an expert panel of

Indian nephrologists.” J Assoc Physicians India 65: 6-22.

14. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J,

Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC (2014)

“evidence-based guideline for the management of high blood pressure in adults: A

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 125

report from the panel members appointed to the Eighth Joint National Committee

(JNC 8).” JAMA 311: 507-520.

15. Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, Tuttle K,

Douglas J, Hsueh W, Sowers J (2000) “Preserving renal function in adults with

hypertension and diabetes: a consensus approach.” Am J Kidney Dis 36: 646-661.

16. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement

DL, Coca A, De Simone G, Dominiczak A, Kahan T (2018) “2018 ESC/ESH

Guidelines for the management of arterial hypertension.” Eur Heart J 39: 3021-3104.

17. Rahman M, Griffin V (2004) “Patterns of antihypertensive medication use in

hemodialysis patients.” Am J Health Syst Pharm 61: 1473-1478.

18. Berbari AE, Daouk NA, Daouk MM (2015) “Chronic Kidney Disease and

Renovascular Interactions.” InArterial Dis p: 299-312.

19. Kalra S,Sahay M, Baruah MP, Agrawal N, Kapoor D, Mitra S (2009) “Management

Of Hypertension In Renal Disease: Results From The Imperial Study.” Int J Fam

Pract 8

20. Kalaitzidis RG, Karasavvidou D and Siamopoulos KC (2011) “Hypertension and

Chronic Kidney Disease: Pathophysiology and Management Strategies.” BANTAO J

9: 49-58.

21. Gupta A, Gupta P (2017) “Hypertension in CKD - Management Issues.” Assoc

Physicians India C: 142.

22. Judd E, Calhoun DA (2015) “Management of hypertension in CKD: beyond the

guidelines.” Adv Chronic Kidney Dis 22: 116-122.

23. Wright Jr JT, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D,

Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L (2002) “Effect of blood

pressure lowering and antihypertensive drug class on progression of hypertensive

kidney disease: results from the AASK trial.” JAMA 288: 2421-2431.

24. Levin NW, Kotanko P, Eckardt KU, Kasiske BL, Chazot C, Cheung AK, Redon J,

Wheeler DC, Zoccali C, London GM (2010) “Blood pressure in chronic kidney

disease stage 5D—A report from a kidney disease: Improving Global Outcomes

Controversies Conference.” Kidney Int 77: 273-284.

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 126

25. Bailie GR, Eisele G, Liu L, Roys E, Kiser M, Finkelstein F, Wolfe R, Port F,

Burrows-Hudson S, Saran R (2005) “Patterns of medication use in the RRI-CKD

study: Focus on medications with cardiovascular effects.” Nephrol Dial Transplant

20: 1110-1115.

26. Sarafidis PA, Sharpe CC, Wood E, Blacklock R, Rumjon A, Al-Yassin A,

Ariyanayagam R, Simmonds S, Fletcher-Rogers J, Vinen K (2012) “Prevalence,

patterns of treatment, and control of hypertension in predialysis patients with chronic

kidney disease.” Nephron Clin Pract 120: 147-155.

27. Okuda T, Okamura K, Shirai K, Urata H (2018) “Effect of angiotensin-converting

enzyme inhibitor/calcium antagonist combination therapy on renal function in

hypertensive patients with chronic kidney disease: Chikushi Anti-Hypertension Trial-

Benidipine and Perindopril.” J Clin Med Res 10: 117.

28. Marín R, Fernández-Vega F, Gorostidi M, Ruilope LM, Díez J, Praga M, Herrero P,

Alcázar JM, Laviades C, Aranda P (2006) “Blood pressure control in patients with

chronic renal insufficiency in Spain: A cross-sectional study.” J Hypertens 24: 395-

402.

29. Magvanjav O, Cooper‐DeHoff RM, McDonough CW, Gong Y, Segal MS, Hogan

WR, Johnson JA (2019) “Antihypertensive therapy prescribing patterns and correlates

of blood pressure control among hypertensive patients with chronic kidney disease.” J

Clin Hypertens 21: 91-101.

30. Ku E, McCulloch CE, Vittinghoff E, Lin F, Johansen KL (2018) “Use of

antihypertensive agents and association with risk of adverse outcomes in chronic

kidney disease: Focus on angiotensin‐converting enzyme inhibitors and angiotensin

receptor blockers.” J Am Heart Assoc 7: e009992.

31. Teo BW, Chua HR, Wong WK, Haroon S, Subramanian S, Loh PT, Sethi S, Lau T

(2016) “Blood pressure and antihypertensive medication profile in a multiethnic

Asian population of stable chronic kidney disease patients.” Singapore Med J 57:

267.

32. Tozawa M, Iseki K, Iseki C, Oshiro S, Higashiuesato Y, Yamazato M, Tomiyama N,

Tana T, Takishita S (2002) “Analysis of drug prescription in chronic haemodialysis

patients.” Nephrol Dial Transplant 17: 1819-1824.

Int. J. Drug Res. Tech. 2019, Vol. 9 (3), 252-270 ISSN 2277-1506

www.ijdrt.com 127

33. Lopes AA, Bragg-Gresham JL, Ramirez SP, Andreucci VE, Akiba T, Saito A,

Jacobson SH, Robinson BM, Port FK, Mason NA, Young EW (2009) “Prescription of

anti-hypertensive agents to haemodialysis patients: time trends and associations with

patient characteristics, country and survival in the DOPPS.” Nephrol Dial Transplant

24: 2809-2816.

34. Manley HJ, McClaran ML, Overbay DK, Wright MA, Reid GM, Bender WL,

Neufeld TK, Hebbar S, Muther RS (2003) “Factors associated with medication-

related problems in ambulatory hemodialysis patients.” Am J Kidney Dis 41: 386-

393.

Correspondence Author:

Amish Uprety*

Nargund College of pharmacy Bangalore, Karnataka, India.

E-mail: Finedust.amish@gmail.com

Tel: +917022670315

Cite This Article: Uprety A (2019) “Study of antihypertensive drug utilization pattern in

chronic kidney disease patients.” International Journal of Drug Research and Technology

Vol. 9 (3) 252-270.